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Ryan, Julia NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Julia Ruth Ryan Female Date of Death Age If Veteran of U.S.Armed Forces, 02/22/2022 90 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc LIJ Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Philip Gara MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 18 ©Burial Date Cemetery,Crematory or Facility Name 02/28/2022 Pine View Cemetery 0 Entombment' Address ❑Cremation Queensbury Town,New York El Donation 0 ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of co ❑Transportation p by Common Shipment Carrier Destination 0 Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom —. Remains are Shipped,If Other than Above g Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/28/2022 Registrar of Vital Statistics ,limee£5llahoney(E/ctronica/T Signer (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF- �1 r� Z Date of Disposition Q .p�p1 Place of Disposition a L �t c( g Quer..A1,S r� %38fly (address) w MirAM.Latarl 8S 6 N (section) of number) (grave number) cc \ a Name of Sexton or Person in Charge of Premises �fe�Y1 Qe�T ZC (please print) W Signature Title `J��Cc f. ,eA s",: JSI DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012901 Receipt Human remains of delivered on 1, 20 Pine View Cemetery Representing the funeral home named pn burial.permit Official Funeral Directors Reg.or License# ^! '; — RYAN NAME Julia Ryan Age: 90 Lot Owner: Roger A & Julia Ryan Lot# Mohican 88 B Grave# 2 Case: Concret Died: 2.2 2.2 2 . Interred:2.2 8.2 2 Funeral Home: Baker FH Cemetery: Pine View